Innovations in less-invasive cardiac care have made open-heart surgery rarer

Misti Crane, The Columbus Dispatch

Sunday

Jan 29, 2012 at 12:01 AMJan 29, 2012 at 10:43 AM

A couple of decades ago, it was far more common to hear someone say they had open-heart surgery. Technological and medical advances have made that a rarer occurrence.

A couple of decades ago, it was far more common to hear someone say they had open-heart surgery.

Technological and medical advances have made that a rarer occurrence.

“The number of open-heart surgeries is about half of what it was 10, 15 years ago,” said Dr. Kevin Hackett, chairman of the department of cardiology for the Mount Carmel Health System. “You’d like to think that people are healthier, but that’s not all of it.”

From 2007 to 2010, the number of coronary artery bypasses (a common reason for open-heart surgery) in Ohio dropped from 34,785 to 27,384. In that same time, the number of angioplasties (a less-invasive approach to eliminating blockages) increased from 12,047 to 15,050.Better medications have helped prevent blockages that require bypass surgery, and less-invasive approaches — particularly stents that hold vessels open — have made surgery less common.

Research shows that the patients who really need open-heart surgery are those with abnormal heart function and blockages in multiple vessels, Hackett said. Doctors commonly recommend surgery for heart patients who also have diabetes because they generally don’t do as well with stents and often end up needing bypass surgery if they start with a less-invasive approach, he said.

If a patient requires a valve replacement on top of having blockages, surgery also is called for.

A major study that found that patients with three blocked arteries often had to come back multiple times for new stents has led many surgeons to recommend bypass in those cases, said Dr. Robert Higgins, director of the division of cardiac surgery and director of surgical care at Ohio State University’s Ross Heart Hospital.

Some of those patients still want the catheter-based treatment, though, because they can go home and back to work in a couple of days.

All of this has made collaboration among medical specialists more important than ever, said Dr. Daniel Watson, chairman of endovascular medicine and surgery at Riverside Methodist Hospital. In the old days, cardiologists and surgeons didn’t talk all that much. That has changed a lot.

“We don’t always see these problems as specialty-based problems, but more as disease-based problems,” Watson said. “I would say pick any point on the map, and we have a minimally invasive approach.”

But it’s not always the best approach. Patients who have long blockages or blockages in small vessels are often better served with bypass surgery, he said.

For six months, Riverside doctors have been meeting regularly to discuss these options. There are still disagreements, but the collaboration is improving patient care, Watson said.

“At good places, it’s a multidisciplinary practice, where there’s a balance of opinions, and it works very well,” said Ohio State’s Higgins. “What we want to make sure is, it’s based upon good evidence and it’s based upon good, objective decision-making.”

If patients are in situations in which they don’t think the risks and benefits of both options are being fully discussed and considered, they should get a second opinion, Higgins said.

Cardiologists and surgeons have professional guidelines and studies that help them sort out the best recommendation for a patient, but “there are always people that fall in between the recommendations, and we talk to them about risks and benefits for each approach,” Hackett said.

“A lot of them have very strong opinions, and they’re much more well-informed than they used to be.”

One of the newest advances in less-invasive approaches is a system that allows doctors to replace the aortic valve through a catheter. It’s used in patients for whom surgery is not a good option.

When people are very old or sick, surgery becomes a risk that surgeons sometimes aren’t willing to take. The catheter-based approach is safe and effective for many of those patients, Watson said.

mcrane@dispatch.com

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